Adolescent Pregnancy and Its Outcomes Across Countries
• Contraceptive use among adolescents is increasing in many countries, as is age at first marriage. Rates of adolescent childbearing have also dropped significantly in many countries and regions over the last few decades.1
• In some regions of the world, however, early childbearing remains common: In 2008, adolescents aged 15–19 in developing countries had an estimated 14.3 million births and 3.2 million abortions.
• Teen pregnancies are associated with poor social and economic conditions and prospects for women, potentially compromising their educational and economic opportunities, or they might be a marker of the environments in which young women live.
ADOLESCENT PREGNANCY IN DEVELOPED REGIONS
• Among 35 developed countries for which adolescent pregnancy rates could be calculated, Romania has the highest rate (61 per 1,000 women aged 15–19 in 2011). Abortion data for Romania are incomplete; therefore, the true pregnancy rate (calculated based on births, abortions and miscarriages) in this country may be even higher than estimated.
• Despite considerable declines in recent decades, the U.S. adolescent pregnancy rate, at 57 per 1,000 in 2010, is the highest in the developed world outside the former Soviet Bloc. The next highest rate is in New Zealand (51 in 2010).
• In Europe (excluding the former Soviet Bloc), the highest adolescent pregnancy rates are found in England and Wales (47 in 2011) and Scotland (46).
• Among the 21 countries with liberal abortion laws and complete teen pregnancy estimates for 2008–2011, the lowest adolescent pregnancy rate is in Switzerland (8 in 2011), followed by the Netherlands and Slovenia (14 in 2008 and 2009, respectively).
• In the majority of the 16 countries with trend data available, adolescent pregnancies have declined since the mid-1990s. The steepest decline occurred in Estonia, followed by Slovenia and Hungary.
• Only in Belgium and Sweden has the adolescent pregnancy rate increased since the mid-1990s. Still, current rates in these countries are low, at 21 (in 2009) and 29 (in 2010), respectively.
ADOLESCENT ABORTION IN DEVELOPED REGIONS
• According to a recent review of 35 developed countries, the highest adolescent abortion rates are in England and Wales and Sweden (20 per 1,000 women aged 15–19 in 2011 and 2010, respectively).
• The next highest rates are in Estonia (19), New Zealand (18), and Romania and Scotland (both 17), all in 2011. The true abortion rate in Romania is likely higher than reported.
• Switzerland has the lowest adolescent abortion rate among countries with complete abortion data (5 in 2011). The next lowest rates are found in Slovakia (6 in 2011), the Netherlands (7 in 2008) and Slovenia (7 in 2009).
• The proportion of adolescent pregnancies that end in abortion varies widely across developed countries, from 17% in Slovakia to 69% in Sweden. In the United States, 26% of adolescent pregnancies end in abortion.
THE UNITED STATES IN CONTEXT
• The adolescent pregnancy rate in the United States has declined considerably (by 51%), from a peak of 117 per 1,000 women aged 15–19 in 1990 to a 30-year low of 57 in 2010. However, the United States has one of the highest known rates of adolescent pregnancy and births in developed regions.
• Information on the proportion of pregnancies that are unintended is not consistently available across developed countries. In the United States, an estimated 82% of adolescent pregnancies are unintended.
• Compared with young people in the Netherlands, who have the second lowest adolescent pregnancy rate in Europe, U.S. adolescents are faced with greater societal disapproval regarding adolescent sexuality, less-consistent provision of sex education, and greater socioeconomic inequalities that underlie higher adolescent pregnancy rates among the most disadvantaged groups.
ADOLESCENT PREGNANCY AND ABORTION IN SUB-SAHARAN AFRICA
For the first time, estimates of adolescent pregnancy and abortion rates are available for four countries in Sub-Saharan Africa: Burkina Faso, Ethiopia, Kenya and Malawi. Adolescent abortion rates for these countries come from hospital-based studies.
• Adolescent pregnancy rates are far higher in these four Sub-Saharan African countries than in developed countries. They range from 121 per 1,000 women aged 15–19 in Ethiopia to 187 per 1,000 in Burkina Faso (both in 2008).
• In these four countries, where abortion is largely illegal, adolescent abortion rates range from 11 in Ethiopia (2008) to 38 in Kenya (2012).
• In Sub-Saharan Africa as a whole, about 35% of pregnancies among 15–19-year-olds in 2007 were unintended. In this region, early marriage and early start of childbearing are common.
FACTORS ASSOCIATED WITH ADOLESCENT PREGNANCY
• Across developed countries, there is relatively little difference in levels of sexual activity among adolescents, but there is substantial variation in levels of contraceptive use.
• Changing social attitudes, including greater acceptance of adolescent sexuality and increased expectation that adolescents will practice contraception, have been linked to higher levels of contraceptive use.
• Recent evidence from Europe and the United States also indicates that the provision of free or subsidized contraceptives is associated with relatively low rates of pregnancy and birth.
• High adolescent birthrates in some former Soviet countries have been attributed to barriers to contraceptive access, such as parental consent requirements, high cost of contraceptive supplies and prescription requirements for some methods.
• In addition, adolescent birthrates appear to be higher in countries where income inequalities are relatively large.2
This fact sheet draws on adolescent pregnancy data, primarily for 2008–2011, for countries in which complete or incomplete data on the rate of abortions was available at the time of writing. Information on rates of abortion, birth and miscarriage were used to calculate pregnancy rates. Thus, for countries with incomplete abortion rate data, pregnancy estimates are also incomplete and likely to be an underestimate.
This research was funded by the Centers for Disease Control and Prevention, through a cooperative agreement between the Office of Population Affairs at the U.S. Department of Health and Human Services and the Guttmacher Institute, and by a grant from the Dutch Ministry of Foreign Affairs.
1. World Health Organization, Maternal, newborn, child and adolescent health: adolescent pregnancy, 2015, http://www.who.int/maternal_child_adolescent/topics/maternal/adolescent_pregnancy/en/
2. Santelli JS, Sharma V and Viner R, Inequality, national wealth, economic development and global trends in teenage birth rates, 1990-2010, Journal of Adolescent Health, 2013, 52(2):S4–S5.